儿童神经原膀胱尿动力学检查的技术控制

对150例神经原膀胱患儿行尿动力学检查。检查前、中、后三个阶段．严格把握尿动力学检查指征，做好患儿及仪器准备、信号控制、数据质量判断及分析等。结果检查准确率100％。其中无反射型膀胱69例，高反射型膀胱56例。结合病史和临床表现诊断为神经原膀胱；余25例检查未发现明显异常，拟诊为遗尿。提示规范的技术控制可使儿童神经原膀胱尿动力学检查结果更客观、准确，为临床诊疗提供有价值的参考依据。     

尿动力学检查在糖尿病患者膀胱功能评定中的意义

目的探讨尿动力学检查在糖尿病患者膀胱功能障碍诊断中的意义。方法伴有下尿路症状(LUTS)的糖尿病患者42例，年龄38～78岁，男24例，女18例。糖尿病发病1个月一25年。结果42例患者完成尿动力学全项检查41例，尿动力学表现异常者38例(93％)，尿动力学表现正常3例(7％)；膀胱逼尿肌收缩减低14例(34％)；膀胱逼尿肌反射消失10例(24％)；膀胱出口梗阻13例(32％，13／41)；女性压力性尿失禁1例。结论伴有LUTS的糖尿病患者膀胱功能异常发生率高，尿动力学检查可以明确膀胱逼尿肌功能，对合并糖尿病的LUTS患者正确诊断和治疗具有重要意义．糖尿病患者行膀胱尿道手术前进行尿动力学检查可提高手术成功率。     

白人和亚洲妇女尿动力学诊断和逼尿肌功能的比较

作者比较了白人和亚洲女性压力性尿失禁患者的尿动力学参数和检查后的最终诊断。作者回顾了2002年1月至2003年12月进行尿动力学检查的女性。尿动力学诊断分为正常、尿动力学压力性尿失禁、逼尿肌过度活动（DOA）或混合性尿失禁。记录逼尿肌过度活动的程度和数量，以及出现初次不自主收缩时的尿量。     

尿动力学检查在女性压力性尿失禁诊治中的应用

目的探讨尿动力学检查在女性压力性尿失禁（SUI）诊治中的应用价值。方法对38例SUI的患者进行尿动力学检查，并根据漏尿点压测定（ALPP）对29例真性压力性尿失禁（GSUI）进行分型，对其中21例患者行经闭孔无张力阴道吊带（TVT-O）术，并对TVT-O术后10例治愈者手术前后的尿动力学指标进行分析。结果38例SUI患者经尿动力学分析，诊断GSUI29例，对其中ALPP分型为Ⅱ型、Ⅱ／Ⅲ型及Ⅲ型的21例患者行TVT-O术，18例治愈，2例好转，1例无效。对术后10例治愈者进行尿动力学测定，结果最大尿道关闭压（MUCP）较术前明显升高（P〈0．05）。结论尿动力学检查在尿失禁的病因鉴别诊断上有重要意义。ALPP对GSUI的诊断、分型、手术方式的选择有参考价值。TVT-O术具有简单、微创、安全、疗效可靠的优点，其机制可能与增加最大尿道闭合压有关。     

尿动力学检查在耻骨上前列腺切除术后尿失禁诊断中的应用

目的:探讨尿动力学检查在耻骨上前列腺切除术后尿失禁诊断中的应用价值。方法:对23例耻骨上前列腺切除术后尿失禁患者进行尿动力学检查,包括膀胱压力容积测定、Valsalva漏尿点压力测定、压力-流率测定、静态尿道压力测定。结果:11例诊断为运动急迫性尿失禁,2例诊断为感觉急迫性尿失禁,5例诊断为压力性尿失禁,3例诊断为混合性尿失禁,2例诊断为充盈性尿失禁。结论:尿动力学检查能准确判断耻骨上前列腺切除术后尿失禁的类型,为治疗提供客观依据。     

子宫脱垂患者行阴式子宫切除术联合阴道前后壁修补术后合并新发性压力性尿失禁的影响因素

目的探究子宫脱垂患者行阴式子宫切除术联合阴道前后壁修补术术后合并压力性尿失禁的相关影响因素,为子宫脱垂患者的个体化治疗提供临床参考依据。 方法选取2017年1月至2019年1月,天长市中医院住院行阴式子宫切除术联合阴道前后壁修补术的患者50例,术前患者已排除急性尿失禁、压力性尿失禁等情况,术后所有患者均顺利出院,术后随访2个月,根据患者的主观症状,体格检查结果、国际尿失禁咨询委员会尿失禁问卷简表以及尿动力学检查诊断并统计术后新发压力性尿失禁患者并对可能造成术后新发压力性尿失禁的因素进行统计分析。 结果（1）子宫脱垂患者行阴式子宫切除术联合阴道前后壁修补术治疗后新发压力性尿失禁患者15例,其中主观症状较为明显患者5例,主观症状及体格检查均无明显异常患者6例,完成问卷量表后方才明确诊断,经尿动力学检查方才明确诊断患者4例。（2）单因素分析发现糖尿病史、体质量指数、巨大胎儿分娩史、盆腔手术史是影响术后新发压力性尿失禁的相关影响因素。（3）以术后是否发生尿失禁作为因变量（0=未发生,1=发生）,将单因素分析中有统计学差异的4个影响因素纳入多因素Logistic回归分析,结果显示糖尿病病史、盆腔手术病史以及巨大胎儿分娩史是阴式子宫切除联合阴道前后壁修补术术后新发压力性尿失禁的独立危险因素。 结论对于合并巨大胎儿分娩史、盆腔手术史、糖尿病病史的子宫脱垂患者可于术前加强与患者的沟通交流,告知患者术后出现新发压力性尿失禁的风险,并在完善相关评估后建议患者同步性抗尿失禁手术以综合改善患者预后,提高患者术后生活质量。     

脊髓发育不良和隐性骶椎裂致神经源性膀胱功能障碍的尿动力学表现

为了解脊髓发育不良和隐性骶椎裂对泌尿系统的影响，对３４例有泌尿系统症状的患者行尿动力学检查和辅助检查。结果显示有反射性膀胱２１例（６１．７％），其中逼尿肌外括约肌协同失调１３例，排尿困难为主要表现；逼尿肌外括约肌协同正常８例，急迫性尿失禁为主要表现。无反射性膀胱１３例（３８．５％），排尿困难、尿潴留为主要表现。１２例膀胱颈口开放患者９例有尿失禁，最大尿道闭合压为３．１７±１．４０ｋＰａ（１ｋＰａ＝１０．２０ｃｍＨ２Ｏ），２２例膀胱颈口闭合患者最大尿道闭合压为７．７７±３．５０ｋＰａ（Ｐ＜０．０１）。１５例ＩＶＵ显示有上尿路损害的患者排尿期膀胱压力为平均８．０１±４．３０ｋＰａ，１９例无上尿路损害的患者排尿期膀胱压力平均为３．０６±１．２０ｋＰａ，（Ｐ＜０．０１）。综合分析显示患者临床症状和尿动力学表现与脊髓损伤平面无对应关系。     

女性尿失禁163例临床及尿流动力学诊断

本文对1982年以来收治的女性尿失禁163例进行临床和尿流动力学诊断对比,两种诊断相吻合者为56％。紧迫性尿失禁88％为运动紧迫性尿失禁。临床诊断压力性尿失禁者仅43.4％为真性压力性尿失禁,运动紧迫性和混合性尿失禁分别为21％和22％,后两者多伴有尿路刺激症状。本文还就尿失禁的尿动力学表现形式及意义进行了讨论。     

尿动力学检查在下尿路症状患者诊断中的价值（附324例报告）

目的：评价尿动力学在下尿路症状（LUTS）患者病因诊断中的重要价值。方法：对324例不同年龄的LUTS患者行尿流率、压力容积、压力-流率、前列腺压和肌电图检查,根据检查结果,行相应的临床治疗措施,比较治疗前后IPSS、QOL的变化。结果：根据尿动力学结果提示LUTS病因有5种,膀胱出口梗阻55．9％、逼尿肌受损、逼尿肌-括约肌失协调、不稳定膀胱、膀胱容量减少。制定相应治疗方案,取得良好临床效果。结论：尿动力学检查揭示LUTS的深层次病因,在LUTS患者的诊断、鉴别诊断及治疗方式的选择上具有重要的意义,值得临床推广应用。     

压力性尿失禁合并糖尿病患者的尿动力学研究

目的 探讨尿动力学检查在压力性尿失禁合并糖尿病中的诊断意义。方法 采用德国Ellipse尿动力检测仪对58例女性压力性尿失禁合并糖尿病患者及40例单纯压力性尿失禁患者进行尿动力学检测,参照不同的糖尿病病程,明确不同时期尿动力学的特征性改变。结果 实验组与对照组相比,两组中以McGuire法分型的各型腹压漏尿点所占百分比具有明显差异;糖尿病病程大于2年患者的尿动力学参数与单纯SUI间差异具有统计学意义(P<0.05),最大尿流率、最大尿流率时逼尿肌压力随病程的增加而降低,而强烈排尿感容量、剩余尿量、最大膀胱测压容量及初始尿意容量均随病程的增加而增加。结论 尿动力学检查的各项指标结合糖尿病病程临床资料,有助于判断压力性尿失禁伴有何种膀胱功能的改变,对正确的诊断及后续治疗具有重要意义。     

The diagnosis of female stress incontinence--the value of the clinical examination, anamnesis and urodynamics]

A prospective study was performed between November 1989 and August 1990 to evaluate 57 consecutive female patients with urinary incontinence. The aim of the study was to determine whether the indication for surgery could be based solely on an anamnestic evaluation and clinical examination or was corrected by an additional urodynamic test. The anamnestic evaluation alone correctly identified all patients with the diagnosis of stress incontinence in our group of selected patients referred by other urologists. The additional clinical examination confirmed this diagnosis in all patients and additionally led to diagnosis of a vesicovaginal fistula in one patient. The urodynamic testing confirmed the clinical and anamnestic diagnosis in all patients and identified urge incontinence as the leading symptom in one patient with an unclear diagnosis. Our results show that urodynamic studies are important to establish a precise indication for surgery but are not necessary in every patient. A possible alternative to routine urodynamic testing in female urinary incontinence is its application only when there is an obvious discrepancy between the carefully evaluated history of incontinence and the findings of the clinical examination.     

The role of urodynamic study in female patients with urinary incontinence]

To determine the type of urinary incontinence in 96 female incontinent patients, we performed a comparative study between the clinical evaluation and the results of urodynamic studies. Their complaints, physical examination, laboratory examinations including routine urological X-ray and ultrasonic studies, revealed that 15 to 30% of the patients had another type of incontinence than those with stress incontinence, urge incontinence and those in whom diagnosis was made from urodynamic studies. Urodynamic studies disclosed that another urinary incontinence type was observed in 7 to 18% of the patients, who were not improved in spite of treatment which was required because of their complaints and physical examination. Our findings showed that urinary incontinence could not be classified according to the frequency of urination or vesical volume. Urodynamic studies may be essential in female patients with urinary incontinence scheduled to have an operation or for whom initial treatment was unsuccessful.     

Are urodynamic tests useful tools for the initial conservative management of non-neurogenic urinary incontinence? A review of the literature

OBJECTIVES: To summarise the evidence for the role of urodynamic tests in the diagnosis and classification of urinary incontinence. METHODS: Reference lists in relevant papers were reviewed and MEDLINE searches conducted. RESULTS: The mean sensitivity (specificity) of clinical history versus urodynamic tests was 0.82 (0.57) for stress incontinence, 0.69 (0.60) for urge incontinence/overactive bladder, and 0.51 (0.66) for patients with mixed incontinence. The proportion of women with a clinical diagnosis of urinary incontinence but with normal findings from urodynamic tests ranged from 3 to 8%. Overall sensitivity of urodynamic tests was about 85-90% in the diagnosis of urodynamic stress incontinence, but generally lower following diagnosis of urge and mixed incontinence. No relationship emerged between urodynamic test results and response to medical treatment. CONCLUSIONS: This literature review shows that the sensitivity of clinical history versus urodynamic tests was 0.82, 0.69 and 0.51 respectively for stress, urge and mixed urinary incontinence. It also suggests that urodynamic diagnosis does not predict response to treatment. These data add to the ongoing 'urodynamics or no urodynamics' debate in the evaluation of urinary incontinence and show that urodynamic testing may not be helpful for patients receiving initial non-invasive therapy. These data are in line with the conclusions of the 1st and 2nd International Consultations on incontinence.     

Final diagnosis and therapeutic implications of mixed symptoms of urinary incontinence in women.

The final diagnosis of 244 females who presented with mixed symptoms of stress incontinence (SI) and urge incontinence (UI) was made based on clinical, urodynamic, and cystoscopic findings. The UD studies consisted of cystometrogram, uroflow and urethral pressure profiles in the supine and standing positions. Diagnosis of genuine stress urinary incontinence (GSI) in 72 patients (30%) was based on the presence of positive Marshall test result or maximum urethral closure pressure 40 cm of water or less, in addition to the symptoms of stress incontinence. Diagnosis of reduced bladder storage (RBS) in 36 patients (15%) was based on MCC 300 mL or less, or the findings of bladder instability on cystometrogram in addition to the symptoms of urge incontinence. Ninety-five patients (39%) with the criteria of both GSI and RBS were classified as the mixed group. The diagnosis of interstitial cystitis in 19 patients (8%) was made according to the criteria outlined by Messing. Urethral stenosis was diagnosed in 6 patients (2%) based on a reduced maximal flow rate by at least 2 S.D. and a tight urethra to F16 calibration at cystoscopy. Sixteen patients (7%) with inconclusive diagnosis had symptoms only of SI and UI but no objective findings. The clinical and urodynamic findings in each group and the results of the surgical and medical treatment are compared.     

DETRUSOR INSTABILITY IN MEN: CORRELATION OF LOWER URINARY TRACT SYMPTOMS WITH URODYNAMIC FINDINGS

PURPOSE: We evaluated the correlation of lower urinary tract symptoms suggestive of detrusor instability with urodynamic findings in men. MATERIALS AND METHODS: Enrolled in our prospective study were 160 consecutive neurologically intact men referred for urodynamic evaluation of persistent lower urinary tract symptoms. All patients had storage symptoms suggestive of detrusor instability. Patients were further clinically categorized according to the chief complaint of urge incontinence, frequency and urgency, nocturia or difficult voiding. The clinical and urodynamic diagnosis in all patients as well as specific urodynamic characteristics of those with detrusor instability were analyzed according to the these 4 clinical categories. RESULTS: Mean patient age was 61 +/- 15 years. The chief complaint was urge incontinence in 28 cases (17%), frequency and urgency in 57 (36%), nocturia in 30 (19%) and difficult voiding in 45 (28%). Detrusor instability was diagnosed in 68 cases (43%). A higher incidence of detrusor instability was associated with urge incontinence than with the other clinical categories (75% versus 36%, p <0.01). Of the patients 109 (68%) had bladder outlet obstruction, including 50 (46%) with concomitant detrusor instability. The prevalence of bladder outlet obstruction was similar in all patients regardless of the chief complaint. All other urodynamic diagnoses were also similar in the 4 clinical categories. The mean bladder volume at which involuntary detrusor contractions occurred were lower in patients with urge incontinence and frequency and urgency than in those with nocturia and difficult voiding (277.1 +/- 149.4 and 267.7 +/- 221.7 versus 346.7 +/- 204.6 and 306.2 +/- 192.1 ml., respectively, not statistically significant, p = 0.07). CONCLUSIONS: Detrusor instability and bladder outlet obstruction are common in men with lower urinary tract symptoms. The symptom of urge incontinence strongly correlated with detrusor instability. Other lower urinary tract symptoms did not correlate well with any urodynamic findings. Therefore, we believe that an accurate urodynamic diagnosis may enable focused and more efficient management of lower urinary tract symptoms in men.     

The role of urodynamic assessment in the diagnosis of lower urinary tract disorders

The relationship between clinical symptomatology and urodynamic findings was studied prospectively in 1000 unselected women with symptoms of lower urinary tract dysfunction. Women in the study were subjected to both clinical and multichannel urodynamic assessment. The symptom of stress incontinence was confirmed by urodynamic assessment to be associated with genuine stress incontinence (95%). However, it was also associated with sensory urgency (96%) and detrusor instability (64%). Other lower urinary tract symptoms were associated with a range of abnormal urodynamic findings. It was concluded that urodynamic assessment provided useful information in women with lower urinary tract disorders, in developing principles of diagnosis and management. EDITORIAL COMMENT: Once again the utility of urodynamic evaluation of women with lower urinary tract symptomatology is clearly apparent. Lower urinary tract symptoms are too unspecific to be the sole basis of treatment, especially surgical intervention. Although this conclusion has been reached by other investigators, there remain far too many clinicians in the fields of primary care, gynecology and urology who continue to doubt urodynamic testing. The fact remains, as shown again by Dr Clarke, that urodynamic assessment is essential in making a diagnosis and formulating a treatment plan.     

A randomized controlled trial of urodynamic investigations prior to conservative treatment of urinary incontinence in the female

Sixty patients complaining of frequency, urgency, nocturia, urge incontinence and stress incontinence were randomly allocated to either undergo conservative treatment by way of combined physiotherapy and bladder retraining as an inpatient without prior urodynamics, or to have urodynamic investigations and treatment tailored to the urodynamic diagnosis. The assessment period was 3 months and assessment was made pre- and posttreatment by urinary diary, pad testing and subjective questionnaire. There was a significant improvement posttreatment for each parameter studied, with the exception of pad testing. There was no significant difference between the two groups for any parameter. Two-thirds of patients were cured to the extent that they did not require further treatment, and again there was no difference between the two groups. We conclude that patients attending for the first time with an uncomplicated story of urinary incontinence can be effectively treated conservatively without prior urodynamics.EDITORIAL COMMENT: The treatment of urinary incontinence based on symptoms rather than urodynamic diagnosis has long been used by physicians, although the validity and success of this approach has been questioned. Dr Ramsay and associates attempt to address this issue of conservative management of urinary incontinence prior to urodynamic evaluation. The study design is clean cut, although the number of patients enrolled is small and the treatment regimen initially requires hospitalization. With more and more emphasis being placed on managed care, empiric therapy based on symptoms rather than the results of expensive urodynamic testing may become the standard approach to female urinary incontinence. Large randomized studies looking at clearly defined outcome measures will be necessary to support this approach.     

Hallazgos urodinámicos en pacientes con enfermedad de Charcot-Marie-Tooth con síntomas del tracto urinario inferior

IntroductionOur aim was to describe the lower urinary tract symptoms (LUTS) and urodynamic findings in Charcot-Marie-Tooth (CMT) disease patients referred to our Urology Department.MethodsRetrospective study of those patients with CMT disease diagnosed at the Neurology Department of our Tertiary Hospital and referred to our Urology Department since 2008 due to LUTS. We reviewed their clinical charts regarding the age at CMT disease diagnosis, type of CMT disease and the presence of other comorbidities which could cause LUTS. We collected data on the characterization of LUTS, findings of neurological examination and urodynamic findings.ResultsSeven patients were referred to our department due to the presence of LUTS. They were 3 male and 4 female, with median age at the moment of LUTS onset of 55 (29-67) years and median time from the diagnosis of the neuropathy to the onset of LUTS was 14 (1-37) years. Voiding symptoms were referred by 5 patients and urinary incontinence by 3 patients. Two patients presented recurrent urinary tract infection. Six urodynamic tests were performed which showed a neurogenic acontractile detrusor in 2 patients, detrusor underactivity in one patient, a delayed opening time in one patient, a neurogenic detrusor overactivity in one patient and a urodynamic stress incontinence in one patient. In one patient the urodynamic test was normal.ConclusionsMost of CMT patients with LUTS complained from voiding symptoms. Several urodynamic findings could be observed mostly during the voiding phase. We recommend performing urodynamic tests in CMT patients presenting with LUTS seeking for treatment or in those with related complications.     

DO URINARY SYMPTOMS CORRELATE WITH URODYNAMIC FINDINGS?

PURPOSE: We determined whether urinary symptomatology correlates with video urodynamic findings. MATERIALS AND METHODS: A total of 115 women with complaints of urinary incontinence completed a 27-item questionnaire. Pelvic examination and video urodynamic study were performed. Subjective findings were scored from 0 to 5, with 5 representing the most severe symptomatology. Patients were divided into 5 subgroups based on etiology of incontinence, and analyzed by Student's t test with p < 0.05 considered statistically significant. RESULTS: Among the 115 patients 11% had normal studies, 38% proximal urethral hypermobility with stress urinary incontinence, 33% intrinsic sphincter deficiency, 11% significant pelvic prolapse and stress urinary incontinence, and 10% detrusor instability. Subjective complaints, such as incontinence during physical activity, were prominent in both stress urinary incontinence groups as well as the prolapse group with stress urinary incontinence. Questions about nocturia, frequency, urgency, urge incontinence, number of pads, number of vaginal deliveries and incomplete emptying were not statistically significant for any group. CONCLUSIONS: Subjective complaints were not helpful in differentiating the etiology of incontinence. Few questions were helpful in predicting which patients would have a normal video urodynamic study.     

Urodynamic characteristics of mixed urinary incontinence and idiopathic urge urinary incontinence

PURPOSE: To evaluate and compare the clinical and urodynamic findings in patients with either mixed urinary incontinence (MUI) or simple urge urinary incontinence (UUI). MATERIALS AND METHODS: A series of 100 consecutive female patients with MUI and UUI were identified from a database. Patients with neurogenic bladder, fistula, urethral diverticulum, prior urologic surgery or known urinary tract obstruction were excluded. All patients were classified according to the urodynamic classification of overactive bladder of Flisser et al. and all patients underwent history, physical examination, validated incontinence questionnaire, 24-hour voiding diary, 24-hour pad test, video urodynamic study (VUDS), and cystoscopy. RESULTS: A significantly higher proportion of patients with UUI exhibited detrusor overactivity at VUDS, (67% of the patients with UUI vs. 24% of the MUI, P < 0.05). Patients with UUI had fewer episodes of incontinence (6.7 vs. 4.2, P < 0.05) with slightly less objective urine loss (24-hour pad test 94 gm vs. 128 g of loss, P < 0.05) and voided at higher pressures (p(det) at Q(max) 21.4 vs. 15.6 cm H(2)O, P < 0.05). Patients in both groups had functional and urodynamic bladder capacities that were not statistically different. CONCLUSIONS: Women with UUI were more likely to exhibit detrusor overactivity but experienced fewer episodes of incontinence and less urinary loss when compared with women who had MUI. The "urge incontinence" component of MUI appears to be different than that of UUI, and suggests that urge incontinence may be overdiagnosed in patients with SUI who misinterpret their fear of leaking (because of SUI) for urge incontinence.